Transtheoretical Model Stage of Change
This patient is in the Contemplation stage (C). 1
Rationale
The patient is actively weighing the pros and cons of knee surgery and is uncertain about proceeding—specifically asking about "complications of delaying the surgery." This behavior is the hallmark of the Contemplation stage, where individuals are aware a problem exists and are seriously considering taking action but have not yet made a commitment to act. 1
Distinguishing Between Stages
Why Not Pre-contemplation (B)?
- Pre-contemplation patients are not yet considering change and may be unaware or in denial about the problem 1
- This patient is already consulting about surgery and actively seeking information about consequences of delay, demonstrating awareness and consideration 1
Why Not Preparation (D)?
- Preparation stage involves patients who have made a decision and are planning concrete steps toward action 1
- This patient has not yet decided whether to proceed—he remains hesitant and is still gathering information to inform his decision 1
Why Not Action (A)?
- Action stage involves patients who have already modified their behavior or undergone the intervention 1
- This patient has not committed to surgery and is still in the decision-making phase 1
Clinical Application to Surgical Decision-Making
The surgeon's role in the Contemplation stage is to facilitate shared decision-making by providing balanced information about both performing and not performing surgery. 1
Key Communication Strategies:
- Present advantages and disadvantages of both surgery and conservative management in a balanced manner, explicitly stating that "different people make different choices" 1
- Explicitly discuss the risks of not operating, particularly when delay carries risk of irreversible consequences such as progression to osteoarthritis or worsening functional status 2, 1
- Ask what makes the patient's life worth living and whether he would accept specific functional limitations to avoid surgery 1
- Avoid steering the patient toward a particular decision while providing medical expertise about outcomes 1
Information to Address His Concerns About Delay:
For knee surgery candidates with moderate-to-severe osteoarthritis, delaying surgery can lead to:
- Increased pain and loss of function 2
- Worsening of medical comorbidities due to limited mobility 2
- Potential progression of joint disease, though this should be balanced against the patient's individual circumstances 2
However, the 2023 ACR/AAHKS guidelines emphasize that there should be no arbitrary waiting period mandated before surgery, as patients in the defined population have typically already attempted nonoperative treatment for an extended period 2